Multiple myeloma (MM), a hematological malignancy, is characterized by malignant plasma cell proliferation in the bone marrow. Recent treatment advances have significantly improved patient outcomes associated with MM.In this study, we aimed to develop comprehensive, evidence-based guidelines for the diagnosis, prognosis, and treat‑ ment of MM. We identified 12 key clinical questions essential for MM management, guiding the extensive literature review and meta-analysis of the study. Our guidelines provide evidence-based recommendations by integrating patient preferences with survey data. These recommendations include current and emerging diagnostic tools, thera‑ peutic agents, and treatment strategies. By prioritizing a patient-centered approach and rigorous data analysis, these guidelines were developed to enhance MM management, both in Korea and globally.

Purpose: Allogeneic hematopoietic stem cell transplantation (HSCT) with optimal conditioning has helped better long-term survival in acute lymphoblastic leukemia (ALL). This study investigated the efficacy and safety of reduced-intensity conditioning (RIC) with busulfan and fludarabine in adult ALL patients unfit for myeloablation. Materials and Methods: Records of 78 patients who underwent HSCT with RIC consisting of 3.2 mg/kg/day of busulfan for 2 or 3 days and 30 mg/m2/day of fludarabine for 5 or 6 days were analyzed. Results: The median age at diagnosis was 49 years. Over a median follow-up of 22 months, 2-year estimates of relapse-free survival (RFS) and overall survival were 57.4% and 68.7%, respectively. Multivariate analysis showed a trend of improved RFS in patients with chronic graft-versus-host disease (GVHD) (hazard ratio, 0.53; 95% confidence interval, 0.26–1.08; p=0.080). The cumulative incidences of relapse and non-relapse mortality were 42.9% and 19.6%, respectively and one case of central nervous system relapse was noted. No hepatic veno-occlusive disease was reported. Grade II–IV acute GVHD and any grade chronic GVHD occurred in 21.1% and 41.7%, respectively. Conclusion RIC with busulfan and fludarabine is an effective and safe conditioning regimen for adult ALL patients unfit for myeloablation.

BACKGROUND: Anemia in chronic renal failure plays an important rolr in increasing morbidity of dialysis patients. The causes of the anemia are multifactorial. With using of erythropoietin(EPO), most of uremia-induced anemia can be overcome. However, about 10% of renal failure patients shows EPO-resistant anemia. Hyporesponsiveness to EPO has been realted to many factors: iron deficiency, aluminum intoxication, inflammations, malignancies and secondary hyperparathyroidism. So I evailuated the improvement of EPO responsiveness after correction of above several factors. MATERIALS AND METHODS: Seventy-two patients on hemodialysis over 6 months were treated with intravenous ascorbic acid(IVAA, 300 mg t.i.w. for 12 weeks). After administration of IVAA for 12 weeks,patients were classified into several groups according to iron status, serum aluminum levels and i-PTH levels. Indivisualized treatments were performed; increased iron supplement for absolute iron deficiency, active vitamin D3 for secondary hyperparathyroidism and desferrioxamine(DFO, 5 mg/kg t.i.w.) for aluminum intoxication or hyperferritinemia. RESULTS: 1) Results of IVAA therapy for 12 weeks on all patients(n=72) Hemoglobin levels at 2,4,6 week were significantly elevated compared to baseline. but those of hemoglobin at 8, 10, 12 week were not significantly different. 2) Result of IVAA therapy for 20 weeks on patients with 100 microgram/1< or =ferritin<500 microgram/1 and transferrin saturation(Tsat) below 30%(n=30) After treatment of IVAA for 12 weeks, patients were evaluated the response of therapy according to iron status. Patient with 100 microgram/1< or =ferritin?500 microgram/1 and Tsat below 30% showed the most effective response. These patients were treated further for 8 weeks. Hemoglobin levels at 2, 4 week were significantly increased compared to baseline with significantly reduced doses of EPO at 2, 4, 10, 12, 16, 20 week. Concomitantly significantly improvement of Tsat at 2, 6, 16, 20 week compared to baseline were identified. 3) Result of IVAA therapy for 12 weeks followed by DFO therapy for 8 weeks on patients with serume aluminum above 4 microgram/1(n=12) Hemoglobin levels were not significantly increased during IVAA therapy for 12 weeks but dosages of EPO were significantly decreased at 2, 4, 6, 8 week during DFO therapy compared to pre-treatment status. CONCLUSION: IVAA can be helpful for the treatment of the anemia caused by functional iron deficiency and can reduce the dosage of EPO for anemia correction. And administration of low dose DFO, in cases of increased serum aluminum level, can reduce the requirment of EPO.
Aluminum ; Anemia ; Ascorbic Acid ; Cholecalciferol ; Deferoxamine ; Dialysis ; Erythropoietin* ; Humans ; Hyperparathyroidism, Secondary ; Inflammation ; Iron ; Kidney Failure, Chronic ; Renal Dialysis* ; Renal Insufficiency ; Transferrin

BACKGROUND: Exit site/tunnel infection causes con-siderable morbidity and technique failure in CAPD patients. We presently use a unique revision method for the treatment of refractory ESl/TI in CAPD patients and mupirocin prophylaxis for high risk patients. MTEHODS: We reviewed one hundred-thirty nine CAPD patients about the ESI/TI from Qctober 1993 to February 1999 at Yeungnam University Hospital. At the beginning of the ESI, we usually started medications with rifampicin and ciprofloxacin and then changed the antibiotics according to the sensitivity test. If the ESI had persisted and there were TI symptoms(purulent discharge, abscess lesion around exit site), we performed catheter revision(external cuff shaving, disinfection around tunnel and new exit site on opposit direction) with a combination of proper antibiotics. We applied local mupirocin ointment at the exit site three times per week to the 34 patients who had the risk of ESI starting from October 1998. RESULTS: The total follow-up was 2401 patient months (pt.mon). ESI occurred on 105 occasions in 36 out of 139 patients, and peritonitis occurred on 112 occasions in 67 out of 139 patients. Cumulative incidence of ESI and peritonitis was 1 per 23.0 pt.mon and 1 per 21.6 pt.mon. The most common organism responsible for ESI was Staphylococcus aureus (26 of 54 isolated cases, 43%), followed by Methicillin resistant S. aureus (MRSA)(13 cases, 24%). Seven patients (5: MRSA, 2: Pseudomonas) had to be treated with a revision to control infection. Three patients experienced ESI relapse after revision. One of them improved with antibiotics, while another needed a second revision and the remaining required catheter removal due to persistent MRSA infection with reinsertion at the same time. But, there was no more ESI in these 3 patients who were received management to relapse (The mean duration : 14.0 months) The rates of ESI were more reduced after using mupirocin than before (l per 12.7 vs 34.0 pt.mon, p<0.01). CONCLUSION: In summary, revision technique can be regarded as an effective method for refractory ESI/TI before catheter removal. Also local mupirocin ointment can play a significant role in the prevention of ESI.
Abscess ; Anti-Bacterial Agents ; Catheters* ; Ciprofloxacin ; Disinfection ; Follow-Up Studies ; Humans ; Incidence ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Mupirocin* ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis ; Recurrence ; Rifampin ; Staphylococcus aureus

BACKGROUND: Exit site/tunnel infection causes cosiderable morbidity and technique failure in CAPD patients. We presently use a unique revision method for the treatment of refractory ESI/TI in CAPD patients and mupirocin prophylaxis for high risk patients. MATERIALS AND METHODS: We reviewed 139 CAPD patients about the ESI/TI from October 1993 to February 1999 at Yeungnam University Hospital. At the beginning of the ESI, we usually started medications with rifampicin and ciprofloxacin and then changed the antibiotics according to the sensitivity test. If the ESI had persisted and there were T1 symptoms(purulent discharge, abscess lesion around exit site), we performed catheter revision(external cuff shaving, disinfection around tunnel and new exit site on opposit direction) with a combination of proper antibiotics. We applied local mupirocin ointment at the exit site three times per week to the 34 patients who had the risk of ESI starting from October 1998. RESULTS: The total follow-up was 2401 patient months(pt. mon). ESI occurred on 105 occasions in 36 out of 139 patients, and peritonitis occurred on 112 occasions in 67 out of 139 patients. The total number of incidences of ESI and peritonitis was 1 per 23.0 pt.mon and 0 per 21.6 pt.mon. The most common organism responsible for ESI was Staphylococcus aureus(26 of 54 isolated cases, 48%), followed by the Methicillin resistant S. auresu(MRSA) (13 cases, 24%). Seven patients(5: MRSA, 2: Pseudomonas) had to be treated with a revision to control infection. Three patients experienced ESI relapse after revision. One of them improved with antibiotics, while another needed a second revision and the remaining required catheter removal due to persistent MRSA infection with re-insertion at the same time. But, there was no more ESI in these 3 patients who were received management to relapse (The mean duration: 14.0 months). The rates of ESI were significantly reduced after using mupirocin than before(1 per 12.7 vs 34.0 pt.mon, p<0.01). CONCLUSION: In summary, revision technique can be regarded as an effective method for refractory ESI/T1 before catheter removal. Also local mupirocin ointment can play a significant role in the prevention of ESI.
Abscess ; Anti-Bacterial Agents ; Catheters* ; Ciprofloxacin ; Disinfection ; Follow-Up Studies ; Humans ; Incidence ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Mupirocin* ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis ; Recurrence ; Rifampin ; Staphylococcus

PURPOSE: This study was undertaken to evaluate the clinical usefulness of Tensilon test, repetitive nerve stimulation test(RNST), single fiber EMG(SFEMG) test and acetylcholine receptor antibody(AchR Ab) assay for making diagnosis of myasthenia gravis(MG). METHOD: These tests were performed in 21 MG patients which were classified into 11 ocular, 5 mild generalized, 4 moderate generalized, and 1 chronic severe MG. RESULT: The overall positivity of Tensilon test, SFEMG and AchR Ab was 95%, 87%, and 76% respectively. The overall positivity of RNST was 67%; 38% on flexor carpi ulnaris, 43% on adductor digiti quinti and 62% on orbicularis oculi muscles. The positivity of each test was higher in generalized MG group than in ocular MG group. But we could observe the statistically significant difference only in the RNST(p<0.05). CONCLUSION: Tensilon test showed the highest positivity in all MG groups. So we would like to recommend the Tensilon test for the diagnosis of MG at first, followed by RNST and AchR Ab assay, and SFEMG would be indicated to MG group which showed relatively low postivity in other tests.
Acetylcholine ; Diagnosis* ; Edrophonium ; Humans ; Muscles ; Myasthenia Gravis*

We investigated HBV markers in serum and cerebrospinal fluid of 50 subjects with neurologic disorders or other disorders, who visited Dept. of neurology, college of medicine, Yeungnam University, from April-1 to August-31 1994 and were performed cerebrospinal fluid analysis to investigate the detection rate of HBV markers in cerebrospinal fluid and the possibility of neurologic disorders associated with HBV infection. The results were as follows. The positivity of HBsAg and. HBV prevalence rate in serum were 6(12.04) and 37(74.0%). Thf, number of patient with HBsAg, only anti-HBV and no markers were 6(12.0%), 31(62.0%) and 13(26.0%), respectively. The positivity of HBsAg and HBV prevalence rate in cerebrospinal fluid were 3(6%) and 18(36.0%). The number of patient with HBsAg, only anti-HBV and no markers were 6(100.0%), 12(38.7%) and 0(0.0%) respectively. The number of patient with virus associated diseases(VAD) and non virus associated diseases(NVAD) were 26(52%) and 24(48%). The HBV prevalence rate in serum of VAD and NVAD groups were 88.5% and 58.3% (p<0.05). The HBV prevalence rate in CSF of VAD and NVAD groups were 53.8% and 16.7%(p<0.05). The HBV prevalence rate in serum and CSF of VAD and NVAD groups were 60.9% and 28.6%
Cerebrospinal Fluid* ; Hepatitis B Surface Antigens ; Herpesvirus 1, Cercopithecine* ; Humans ; Nervous System Diseases ; Neurology ; Prevalence

High frequency ventilation (HFV) is a new ventilatory technique that uses very small tidal volume (less than the anatomic dead space) and high frequency, and classified 4 distinct types according to frequency and mode of gas delivery. The mechanism of gas transport of high frequency oscillation ventilation (HFOV) is somewhat different to other types of HFV. To evaluate the determinants of PaCO² in HFOV, a study was done with a HFOV on 9 cats, and the results are: 1) PaCO² was not correlated with frequency at the constant stroke volume (6 voltage) and bias flow (6 L/minutes). 2)PaCO² was correlated with stroke volume but not with bias flow under the constant frequency (15 Hz/min) and bias flow (3 to 6 L/min). From above results, the main determinant of PaCO² on artificial ventilation with HFOV was stroke volume, but further study between flow, the site of delivery to the airway and humidification of bias flow and CO² elimination is required in future research.
Animals ; Bias (Epidemiology) ; Cats* ; High-Frequency Ventilation* ; Stroke Volume ; Tidal Volume ; Ventilation